title: Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment.
abstract: OBJECTIVE
  For anterior communicating artery (ACoA) aneurysms, endovascular coil embolization constitutes a safe alternative therapeutic procedure to microsurgical clip occlusion. The authors' aim in this study was to evaluate the quality of life (QOL), cognitive function, and brain structure damage after the treatment of ruptured ACoA aneurysms in a group of patients who underwent microsurgical clipping (36 patients) compared with a reference group who underwent endovascular coiling (14 patients).
  
  
  METHODS
  At 14 months posttreatment all patients underwent evaluations by independent observers. These observers evaluated global efficacy, executive functions using a frontal assessment battery of tests (Trail making test, Stroop tasks, dual task of Baddeley, verbal fluency, and Wisconsin Card Sorting test), behavior dysexecutive syndrome (the Inventaire du Syndrome Dysexécutif Comportemental questionnaire [ISDC]), and QOL by using the Reintegration To Normal Living Index. Brain damage was analyzed using MR imaging.
  
  
  RESULTS
  In the microsurgical clipping and endovascular coiling groups, the distribution on the modified Rankin Scale (p = 0.19) and mean QOL score (85.4 vs 83.4, respectively) were similar. Moreover, the proportion of executive dysfunctions (19.4 vs 28.6%, respectively) and the mean score on the ISDC questionnaire (8.9 vs 8.5, respectively) were not significant, but verbal memory was more altered in the microsurgical clipping group (p = 0.055). Magnetic resonance imaging revealed that the incidence of local encephalomalacia and the median number of lesions per patient increased significantly in the microsurgical clipping group (p = 0.003).
  
  
  CONCLUSIONS
  In the 2 groups, no significant difference was observed regarding QOL, executive functions, and behavior. Despite the significant decrease in verbal memory after microsurgical clipping, the interdisciplinary approach remains a safe and useful strategy.
authors.affiliation: Departments of Neurosurgery, Rouen University Hospital, Rouen, France. Francois.Proust@chu-rouen.fr
authors.forename: François
authors.initials: F
authors.lastname: Proust
authors.forename: Olivier
authors.initials: O
authors.lastname: Martinaud
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gérardin
authors.forename: Stéphane
authors.initials: S
authors.lastname: Derrey
authors.forename: Sophie
authors.initials: S
authors.lastname: Levèque
authors.forename: Sandrine
authors.initials: S
authors.lastname: Bioux
authors.forename: Eléonore
authors.initials: E
authors.lastname: Tollard
authors.forename: Erick
authors.initials: E
authors.lastname: Clavier
authors.forename: Olivier
authors.initials: O
authors.lastname: Langlois
authors.forename: Olivier
authors.initials: O
authors.lastname: Godefroy
authors.forename: Didier
authors.initials: D
authors.lastname: Hannequin
authors.forename: Pierre
authors.initials: P
authors.lastname: Fréger
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D001925:Brain Damage, Chronic / Q000209:etiology* / Q000523:psychology*; D002548:Cerebral Revascularization; D015331:Cohort Studies; D003863:Depression / Q000209:etiology / Q000523:psychology; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000209:etiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011788:Quality of Life; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery; D014057:Tomography, X-Ray Computed